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Texas rates for HCPCS 50694

Placement of ureteral stent, percutaneous, including diagnostic nephrostogram and/or ureterogram when performed, imaging guidance (eg, ultrasound and/or fluoroscopy), and all associated radiological supervision and interpretation; new access, without separate nephrostomy catheter

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$870.96 / $3,467.37 / $12,022.64
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,691.53 / $4,897.79 / $9,772.37
Baylor Scott & White
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,659.59 / $3,548.13 / $5,011.87
Christus
Facility/Professional
Facility
Modifier
Low / Median / High Price
$223.87 / $2,630.27 / $2,630.27
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,398.83 / $2,398.83 / $2,398.83
Lucent Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$54.95 / $56.23 / $9,332.54
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$269.15 / $1,230.27 / $4,677.35
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$251.19 / $912.01 / $1,995.26
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,698.24 / $5,248.07 / $10,964.78